摘要目的 比较不同术式治疗双侧慢性硬膜下血肿的疗效及其影响因素.方法 回顾性分析首都医科大学附属北京天坛医院神经外科201 1年1月至2016年12月采用钻孔引流术治疗的双侧慢性硬膜下血肿患者的临床资料,共134例.其中单侧手术者30例,双侧手术者104例,比较不同术式患者脑组织复位的差异(将术后1周内双侧脑组织复位至与颅骨内板距离＜ 10 mm定义为复位良好),分析影响脑组织复位的相关因素.结果 134例患者中,术后7d内,52.2％(70例)脑组织复位良好;其中双侧手术组为57.7％ (60/104),单侧手术组为33.3％ (10/30),差异有统计学意义(P=0.023).术后24 h内,单侧手术组一侧血肿增大的发生率为63.3％ (19/30),双侧手术组为16.3％ (17/104) (P＜0.001).术后7d内,单侧手术组一侧血肿增大的累积发生率为60.0％(18/30),双侧手术组为6.7％ (7/104) (P ＜0.001).多因素logistic回归分析显示,手术方式(OR=0.251,95％ CI:0.087～0.722,P=0.010)是影响脑组织复位的独立因素.结论 相较于单侧手术,双侧钻孔引流术治疗慢性硬膜下血肿,能提高双侧脑组织的复位效果,降低术后一侧血肿增大的比率.

abstractsObjective To investigate the efficacy and influencing factors of different surgical treatment of bilateral chronic subdural hematomas.Methods A retrospective analysis was performed on 134 patients with bilateral chronic subdural hematomas treated with drilling and drainage from January 2011 to December 2016 at Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University.There were 30 patients undergoing unilateral surgery and 104 patients undergoing bilateral surgery.The differences in brain tissue restoration between 2 surgical strategies were compared.Resetting the bilateral brain tissues within 1 week postoperatively to a distance of less than 10 mm from the inner table of skull was defined as good recovery.The relevant factors that affected brain tissue resetting were analyzed.Results Of the 134 patients,52.2％ (70) had a good brain tissue resetting within 7 days postoperatively,including 57.7％ (60/104) in the bilateral surgery group and 33.3％ (10/30) in the unilateral surgery group (P =0.023).Within 24 hours after surgery,the incidence of hematoma enlargement on one side was 63.3％ (19/30) in the unilateral surgery group and 16.3％ (17/104) in the bilateral surgery group (P ＜0.001).Within 7 days after operation,the cumulative incidence of hematoma enlargement on one side in the unilateral surgery group was 60.0％ (18/30) and 6.7％ (7/104) in the bilateral surgery group.The difference was statistically significant (P ＜ 0.001).Multivariate logistic regression analysis showed that the surgical method (OR =0.251,95％ CI:0.087-0.722,P =0.010) was an independent factor affecting brain tissue remodeling.Conclusion Compared with unilateral surgery,bilateral drilling drainage in the treatment of chronic subdural hematomas could improve the efficacy of restoration of bilateral brain tissues and help reduce the likelihood of hematoma enlargement after surgery.